GMC PACIFIC CRUISERS
Membership Application

FMCA MEMBER No:(required) or Applied For Send Application
Last Name: First Name: MI:
Spouse:    First Name: MI:
Street Address: 
City:   State:   Zip Code: 
Home Phone:      Cell Phone: 
E-Mail Address:   


Birthday (mo/da): Spouse (mo/da): Anniversary (mo/da):


License/State: Year: Model:
GMC Vehicle TZE No:
Mo/Yr GMC Purchased: Total Miles on Coach:


Name Badges will include first names as listed above unless nickname or
other preference(s) are indicated here:
Husband: Spouse:
Badge Fastener Type:Pin Clip Bolo


If an emergency were to occur at a rally, state whom you want contacted:
Name: Phone: 


The GMC Pacific Cruisers Newsletter includes a "Spotlight on New Members"
for the purpose of acquainting the Membership with you.  Please provide any
information you would like to share such as employment, service clubs, hobbies,
special interests, unusual travel experiences, etc.


Occupation (Husband): (Spouse):
Other Information:
History / Bio (please keep to about 50 words):

Instructions: Type your information into this online form and print.
Please mail the completed application along with a check for $25.00 payable
to GMC Pacific Cruisers to Suzanne Covington, 1399 N. Shirlmar Ave., San Dimas,
CA 91773